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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700235
Report Date: 03/07/2025
Date Signed: 03/07/2025 03:42:21 PM

Document Has Been Signed on 03/07/2025 03:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EL RIO MEMORY CARE COMMUNITYFACILITY NUMBER:
502700235
ADMINISTRATOR/
DIRECTOR:		THERESA PETTAPIECEFACILITY TYPE:
740
ADDRESS:2828 HEALTHCARE WAYTELEPHONE:
(209) 543-3805
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 72CENSUS: 59DATE:
03/07/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Reshmika Sharma, Director of Resident ServicesTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 03/07/25, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to conduct a Case Management visit. LPA Campbell met with Reshmika Sharma, Director of Resident Services (DRS) and explained the purpose of the visit. After requesting a roster of staff and hospice residents, LPA Campbell obtained the client Admission Agreements, admission orders from hospice, POA/resident hospice agreement the initial doctors referral for Hospice and conducted a tour of the facility and attempted to interview clients.

The facility is licensed to service 72 clients, 15 hospice clients and is approved for delayed egress. Of the 15 hospice clients, LPA Campbell attempted to observe and interview 5 clients. Of those 5 clients, 4 of them (R1. R3, R4, R5) were either sleeping or declined to interact with LPA Campbell. LPA Campbell was able to speak to and observe R7 in their bed to confirm she was able to reposition herself in her bed and was thus not bedridden. R7 confirmed she was fine and that she liked living in the facility. R3 was also observed sitting up in a lounger watching a movie.

LPA Campbell spoke with Reshmika Sharma, DRS regarding the facility. Hospice clients have case managers and nurses who visit them once a week. During the day, there is a nurse and Med Tech for the AM, PM and NOC shifts. Per DRS Sharma, there are 15 hospice clients in all currently. There are four third party hospice nurses assigned 2 to 3 clients each. There are also 2 to 3 third party shower aids that help clients with their bathing needs.. Facility staff also have 6 caregivers who assist 2 or 3 residents each along with 1 nurse and med tech every shift. Both hospice staff and facility staff (RA, nurses and Med Techs) work in tandem to service the clients regardless of if they are in hospice or not.

DRS Sharma provided the requested documentation. Because the facility does not maintain the signed hospice agreements or doctors referrals on site, they instead had to request it from the different hospice companies they work with. DRS Sharma was able to obtain this documentation during the visit. However
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: EL RIO MEMORY CARE COMMUNITY
FACILITY NUMBER: 502700235
VISIT DATE: 03/07/2025
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the facility does maintain the required admission documentation from the third part hospice service.
When asked, DRS Sharma stated they had reviewed the hospice care waiver increase regulation and that they wanted to increase the number of hospice to 18 and would be willing to hire more staff. At LPA Campbell's request, DRS Sharma will send the signed hospice initiation forms for the selected hospice residents by end of day Monday.

Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, no deficiencies are being cited.
An exit interview was conducted with Rashmika Sharma, DRS and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC809 (FAS) - (06/04)
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